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Viral hepatitis
OP12 UK experience of treatment of chronic viral hepatitis C in children and adolescents: predictors of viral response and quality of life
  1. M Abdel-Hady1,
  2. S Bansal2,
  3. S Davison2,
  4. M Brown3,
  5. S Tizzard1,
  6. S Mulla2,
  7. P Davies3,
  8. G Mieli-Vergani1,
  9. D Kelly1
  1. 1Liver Unit, Birmingham Children's Hospital, UK
  2. 2Paediatric Liver Centre, King's College Hospital, UK
  3. 3Leeds Teaching Hospitals, UK

Abstract

Aim The aim of this study was to review efficacy, tolerability and quality of life (QoL) in children with chronic hepatitis C (HCV) treated with pegylated interferon (PEG-IFN) alfa2a and ribavirin in 3national specialised referral centres in the UK.

Method Demographic, laboratory and clinical outcome data on children up to 18 years of age treated for HCV with PEG-IFN alfa2a and ribavirin were reviewed. Information gathered from QoL questionnaires (CHQ-PF28) completed by parents during their children's treatment was also available for one of the centres. Sustained viral response (SVR) was defined as undetectable HCV RNA at 24 weeks following end of treatment.

Results The study sample comprised 75 children of whom 38 were males. The median age at the start of the treatment was 10 years (3.0–17.2 years). The most common mode of infection (83%) was via maternal transmission. Thirty-four patients were Genotype 1 (G1); 39 Genotype 2&3 (G2&3); 2 Genotype 4 (G4). SVR was achieved in 47 (73.4%); 53% G 1; 90% G 2&3; 100% G 4. There was no significant difference between baseline ALT and/or AST levels in those who achieved SVR compared to the non-responder group. However the first group had at least 30% lower ALT and /or AST levels at 24 weeks post-treatment compared to the latter group p=0.003 and p=0.001, respectively. Children starting treatment <5 years of age had higher SVR compared to older age groups, however this was not statistically significant p=0.7. Low viral load at the start of the treatment (<500 000 IU/mL) did not have significant effect on viral response p=0.5. Early viral response (EVR) at 12 weeks of treatment was achieved in 46 and sustained in 40/46 (87%). Data on rapid viral response (RVR) at 4 weeks of treatment were available in 25; 17/25 (68%) achieved response which was sustained in 16 (94%). There was no significant change in the z scores for weight and height from start of treatment compared to 24 weeks post treatment follow-up (p 0.2 and 0.5, respectively). Data on QoL were available for 31/75 children and their families. At 12 weeks of treatment the child's general health was perceived to be poorer with limitation of physical activity and higher frequency of pain compared to other stages of treatment with values returning to baseline at the end of treatment and at follow up. There were no serious side effects reported and none discontinued treatment due to side effects.

Conclusion HCV treatment with PEG-IFN and ribavirin is well tolerated by children with minimal negative impact on the quality of life of a cohort of the studied children and no significant effect on growth. EVR and RVR are good predictors of treatment response.

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